Improve collaboration with your providers
Essentials Capabilities
Patient Management
Providers need access to the most up-to-date payer information available to avoid denials and collect the appropriate payment from the patient. The Patient Management workflow includes the following:
- Eligibility and benefits: Quickly check whether a patient has coverage, if the provider is in network, and the patient’s coverage for all participating payers.
- Member ID card: Download and print a copy of the patient’s insurance ID card.
- Care reminders: Receive notification when a patient has an outstanding service.
- Additional benefit information: Receive payer information that’s not included within the x12 271 response.
- Patient cost estimator: Provide the patient with and estimate of the service.
Claims Management
The claims management workflow allows providers to submit and track claims electronically, reducing calls to your call center and eliminating the need for fax and mail.
- Claim submission: Submit individual claims through the Portal user interface or multiple claims via a batch file.
- Claims correction: Correct a claim that’s already been submitted.
- Claim status: Check to see if the claim has been adjudicated or if any additional documentation is needed.
- Overpayment and appeal: Respond to a payer’s request with appropriate documentation or initiate a denial appeal.
Remittances
You can deliver the Electronic Remittance Advice (ERA) or 835 data to providers through the remittance viewer tool. Providers can research claims and payments, and because the data is in a human-readable format, rather than ANSI code, it’s easy for non-technical people to understand.
Provider Information Management
Keeping provider information current is a challenge, but Availity’s Provider Data Management (PDM) is designed to help you do just that by letting providers update demographic information through Availity Essentials. Learn more.
Provider Engagement
Essentials offers multiple channels in which to share information with providers, reducing calls into the call center and prompting providers to take an action.
- Messaging: Allows a provider to initiate a one-to-one, online discussion with a payer representative.
- Notifications: Generates a targeted communication that providers see when logging into Essentials.
- Promotions: Delivers a banner ad highlighting a payer initiative.
- News and announcements: Communicates important, time-sensitive information to providers on the main Essentials page.
Authorization and Referral Management
Essentials helps you streamline the authorization process by giving providers a central location where they can check if an authorization is needed, submit the authorization with required documentation, and manage it all through a user-friendly dashboard.
Payer Spaces
While Essentials is a multi-payer tool, health plans still need a place to host proprietary, plan-specific information or tools. Payer Spaces gives you a secure location—branded with your organization’s logo—where providers can access this information.
Availity 360
Availity 360 uses administrative data, transactional data and other Portal activity to give you a clear picture of the network’s health. With Availity 360, you can identify trends and drill down into performance metrics based on payer, transaction type, and more.
Looking to do more with Essentials? View our Clinical Gateway capabilities.
